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Dr. Bob is Robert Hsiung, MD,
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Posted by Tomatheus on January 26, 2016, at 16:26:36
In reply to ALL OK, posted by Escapee on January 26, 2016, at 9:23:08
Escapee,
Thank you for sharing how your appointment with your pdoc went. So, are you currently taking isocarboxazid, along with amitriptyline and nootropics? Also, if you don't mind me asking, what nootropics are you currently taking? And what do they seem to help with?
Enough questions from me, though. I'm glad to hear that you could tell your pdoc that you were feeling better. Take care.
Tomatheus
Posted by Escapee on January 26, 2016, at 18:11:32
In reply to Re: ALL OK » Escapee, posted by Tomatheus on January 26, 2016, at 16:26:36
> Escapee,
>
> Thank you for sharing how your appointment with your pdoc went. So, are you currently taking isocarboxazid, along with amitriptyline and nootropics? Also, if you don't mind me asking, what nootropics are you currently taking? And what do they seem to help with?
>
> Enough questions from me, though. I'm glad to hear that you could tell your pdoc that you were feeling better. Take care.
>
> TomatheusHi Tomatheus. Yes I've increased the isocarboxazid from 110.5 to 140mg/day which has really helped increase my mood. Kept the amitryptyline at 150mg/day. Its the isocarboxazid I wanted increased and the 150mg amitryptyline to stay at 150mg/day. He agreed to both. I cant thank him enough! He did say i seem to tolerate isocarboxazid alot!
Also kept the 300mg/day bupropion and clonazepam stayed at 4mg/day (been on that dose nearly 10yrs! It seems to be one of the less "more-ish" benzos going and once you are at your peak level you can stay there indefinitely. BUT that seems to only apply to Social anxiety. GAD & Panic disorder sufferers apparently dont have this levelling out effect and are more likely to develope tolerance/withdrawal symptoms. And the 250mg quetiapine also stayed the same. I am curious as to how much quetiapine is adding to the mood lift. I may try dropping a dose or 2 just to see what effect that has.
Nootropics? Well I have experimented with several. Piracetam is slightly mind clearing, Aniracetam is both calming and slightly psychostim. Penylpiracetam is very stimulating and can cause tolerance. Tried a few small doses then ditched it. Oxiracetam, a metabolite of aniracetam is mildly stimulating, with a clear mind, increased memory recall & quicker thinking. ALSO antidressive! The other 2 I always take is citicoline & alpha-GPC, both of which are acetylcholine precursors and citicoline is mildly stimulating itself.These 2 precursors also have an important role if u taking racetams, which use up acetylcholine stores so u need a precursor. Choline bitartrate is very poorly absorbed.
I've also found Siberian ginseng a great motivator if u dont use caffein.
Just for those interested, acetylcholine is a neuro transmitter which seems to 'tune' the brain to work harder, especially for thinking & memory, something many SA sufferers like myself have poor cognition. And as it 'wakes' the brain up it is stimulating, but no change in heart rate or bp. Helps my SA when I cant think of anything to say! lolSorry for the long ramble or if I wrote anything not clear enough. For nootropics simply wiki them. But you will struggle to find any research on isocarboxazid.
Escapee.
Posted by Tomatheus on January 26, 2016, at 21:06:59
In reply to Re: ALL OK » Tomatheus, posted by Escapee on January 26, 2016, at 18:11:32
Escapee,
Thank you for your detailed response! Everything that you wrote seemed pretty clear to me, and I found what you wrote regarding racetams and other nootropics to be particularly of interest. Cognition has definitely been an issue for me since around 2007, and though the trials I've had with racetams and most other nootropics haven't been successful up to this point, I haven't ruled out trying some nootropics again. I currently take vitamin D3, which might be of some benefit as far as cognition is concerned, at least in part because of its ability to boost the activity of choline acetyltransferase (the enzyme that synthesizes acetylcholine). In addition to vitamin D3, I also take curcumin and zinc, and I understand that both of these supplements might be of some use to individuals who are looking to boost their cognition.
Anyway, though, thanks again for answering my questions as thoroughly as you did. I hope that you'll continue to benefit from the treatments that you're using at least as much down the road as you are now.
Tomatheus
Posted by john locke on January 27, 2016, at 5:44:26
In reply to Re: ALL OK » Tomatheus, posted by Escapee on January 26, 2016, at 18:11:32
clonazepam stayed at 4mg/day (been on that dose nearly 10yrs! It seems to be one of the less "more-ish" benzos going and once you are at your peak level you can stay there indefinitely. BUT that seems to only apply to Social anxiety. GAD & Panic disorder sufferers apparently dont have this levelling out effect and are more likely to develope tolerance/withdrawal symptoms.
Really? That doesn't really make sense to me, because i feel like any benzo will diminish anxiety through the exact same mechanism. You haven't noticed a diminishing effect for 10 whole years?? I'm very interested by this. How do you split your doses?
John
Posted by SLS on January 27, 2016, at 6:52:57
In reply to Re: ALL OK, posted by john locke on January 27, 2016, at 5:44:26
I would think that anything that increases acetylcholine (ACh) tone would cause depression rather than prevent it.
Acetylcholine cholinesterase inhibitors(physostigmine, donepezil, rivastigmeine, galantamine, etc), drugs that increase ACh levels, induce depression whereas ACh muscarinic receptor antagonists like scopolamine improve depression. This assumes that muscarinic receptors in areas involved in depression predominate over nicotinic ACh receptors, which some suggest can improve depression.
1. pro-ACh = depressive - enhanced cognition and memory
2. anti-ACh = antidepressive - impaired cognition and memoryThese are simplistic generalizations. I'm sure things are more complicated than this. If the 'racitams improve depression, I'm not sure how they do it.
- Scott
Posted by Escapee on January 27, 2016, at 8:15:46
In reply to Re: ALL OK, posted by SLS on January 27, 2016, at 6:52:57
> These are simplistic generalizations. I'm sure things are more complicated than this. If the 'racitams improve depression, I'm not sure how they do it.
>
>
> - ScottVia dopamine? this wiki page has references but im not to great with reading science lol
https://en.wikipedia.org/wiki/Citicoline
Posted by Escapee on January 27, 2016, at 8:34:39
In reply to Re: ALL OK, posted by john locke on January 27, 2016, at 5:44:26
> clonazepam stayed at 4mg/day (been on that dose nearly 10yrs! It seems to be one of the less "more-ish" benzos going and once you are at your peak level you can stay there indefinitely. BUT that seems to only apply to Social anxiety. GAD & Panic disorder sufferers apparently dont have this levelling out effect and are more likely to develope tolerance/withdrawal symptoms.
>
> Really? That doesn't really make sense to me, because i feel like any benzo will diminish anxiety through the exact same mechanism. You haven't noticed a diminishing effect for 10 whole years?? I'm very interested by this. How do you split your doses?
>
> JohnI cannot remember exactly why but ive switched to equivalant doses of valium and temazepam and they feel totaly different. close to euphoric but clonazepam seems to cause depression in some individuals. and ive never found clonazepam euporic. i find it helps with relaxing muscles and tension. and it really helps with me not worrying about what i just said and less SA flashbacks, embarrasment but slows me downsomewhat. if i find the link ill post it. i do know that clonazepam & alprazolam are the 2 top benzos for SA. clonazepam for longer term treatment then alprazolam for a quick fix? strangely we dont have alprazolam here in the uk but you can order it thru ur doc. i was toll it would cost £3/day. but i wouldn't take it anyway.
probably not answered your question very well.
sorry
Posted by Christ_empowered on January 27, 2016, at 9:26:12
In reply to Re: ALL OK » john locke, posted by Escapee on January 27, 2016, at 8:34:39
xanax is sometimes more...problematic...than other benzos. Not that Klonopin is necessarily problem free, of course. I think dosage escalation is more of a problem with xanax (at least, the original IR version; there's an XR version out now).
Posted by SLS on January 27, 2016, at 10:18:23
In reply to Re: ALL OK » SLS, posted by Escapee on January 27, 2016, at 8:15:46
Hi.
> > These are simplistic generalizations. I'm sure things are more complicated than this. If the 'racitams improve depression, I'm not sure how they do it.> Via dopamine? this wiki page has references but im not to great with reading science lol
> https://en.wikipedia.org/wiki/CiticolineThanks. That's very interesting.
- Scott
Posted by swim on January 27, 2016, at 11:57:11
In reply to ALL OK, posted by Escapee on January 26, 2016, at 9:23:08
I told my psychiatrist today that i'v raised my pregabalin dosage from 300mg to 450mg whereupon she said i'm self-medicating and walked off.
Posted by Escapee on January 27, 2016, at 12:22:01
In reply to Re: ALL OK, posted by swim on January 27, 2016, at 11:57:11
> I told my psychiatrist today that i'v raised my pregabalin dosage from 300mg to 450mg whereupon she said i'm self-medicating and walked off.
Change doc? Find a neuro-psychopharmacology clinic?
Most of my positive outcomes have began with ideas Ive taken to my appointment. If u r in UK then ur GP can refere you to ur nearest psychopharmacology dept. Good idea to find it yoursef 1st.
Is taking 450mg going over the official limit? Does it help more? I have always made double sure that the powers that be do not send me to a standard Psychiatrists. Usually scared of old drugs but quite happy to give u new meds which they dont know a thing about.
Posted by Escapee on January 27, 2016, at 12:43:13
In reply to Re: ALL OK » john locke, posted by Escapee on January 27, 2016, at 8:34:39
Just a quickie. People seem to look at my MAOI dose as shocking. But when I tell you I've been on 90mg over 5yrs then 105mg for 2 months untill now where I take 140mg. I'm curios as to why the recommended dose is so low. Also with phenelzine 120mg before i switched.
Posted by Escapee on January 27, 2016, at 12:55:33
In reply to Re: ALL OK » Escapee, posted by Tomatheus on January 26, 2016, at 16:26:36
Incase anyone is interest I have ordered some Sulbutiamine. Said to be an energy giver, it is a easier form of thiamine (vit b1) which crosses the bbb easily. I dont know how or why it increases energy but ive also read that its possible to build resistance with daily administration. So, maybe use it in the week for work then stop during the weekend. Or 3-4 days on/3-4 day off. Looking forward to giving my account. I'm sure I've seen write about sulbutiamine on here before?
Escapee
Posted by Tomatheus on January 27, 2016, at 16:03:08
In reply to Re: ALL OK, posted by SLS on January 27, 2016, at 6:52:57
> I would think that anything that increases acetylcholine (ACh) tone would cause depression rather than prevent it.
Generally speaking, I tend to agree with you, Scott. However, as far as vitamin D is concerned, it's my understanding that the vitamin's effects on various systems in the body are far reaching and that the vitamin's effect on the choline acetyltransferase enzyme is just one of the vitamin's many effects. As far as neurotransmission is concerned, it's my understanding that vitamin D also boosts the activity of the tyrosine hydroxylase and tryptophan hydroxylase 2 enzymes, which respectively serve to synthesize dopamine, norepinephrine, adrenaline, and brain serotonin. It's also my understanding that vitamin D has been implicated in regulating oxidative stress, inflammation, nerve growth factor, and telomere length, all of which are biological factors that have been found to be abnormal in individuals with depression. Scientific review articles have found that vitamin D levels tend to be low in individuals with depressive disorders, and one review article concluded that vitamin D3 supplementation may serve as an effective treatment for depression. It's my understanding that the causality surrounding the relationship between low vitamin D levels and depression isn't entirely clear. I know that one study found evidence to support the idea that low vitamin D levels are a consequence of depression and not the other way around, but I also think I remember reading that more research needed to be done before anything more conclusive could be determined. Regardless as to how low vitamin D levels and depression are related from a causal standpoint, I think that vitamin D should, for the most part, be regarded as an exception to the idea that anything that increases acetylcholine would cause or worsen depression. Vitamin D affects enough other biological systems in ways that would, if anything, only seem to relieve depression, and since some studies have found vitamin D3 supplementation to have antidepressant properties, I don't think it's likely that vitamin D would worsen depression in most individuals. That's not to say that there can't be exceptions, though.
Tomatheus
Posted by SLS on January 27, 2016, at 19:27:44
In reply to Re: ALL OK » SLS, posted by Tomatheus on January 27, 2016, at 16:03:08
I'm taking 5000 IU/day of vitamin D3. Maybe I should take more?
- Scott
Posted by Tomatheus on January 27, 2016, at 22:01:49
In reply to Re: ALL OK » Tomatheus, posted by SLS on January 27, 2016, at 19:27:44
> I'm taking 5000 IU/day of vitamin D3. Maybe I should take more?
Hi Scott,
Even though I wouldn't rule out the possibility that increasing your vitamin D3 dose might lead to a reduction in the symptoms of your bipolar depression, I haven't come across any evidence that would specifically support the idea that taking much more than 5,000 IU would be superior to your current 5,000-IU dose. Of the studies I'm aware of that have found antidepressant benefits from vitamin D3 supplementation, one (Khoraminya et al., 2013) found that just 1,500 IU of vitamin D3 with fluoxetine daily was superior to fluoxetine alone after just six weeks, a second (Gloth et al., 1999) found that a single 100,000-IU dose of vitamin D significantly reduced depressive symptoms in patients with seasonal affective disorder one month after they received their dose of the vitamin, and a third (Jorde et al. 2008) found that individuals with depression and obesity responded significantly more favorably to both 20,000 IU and 40,000 IU of vitamin D3 weekly (which would amount to daily respective amounts of 2,857 IU and 5,714 IU) compared to placebo as far as depressive symptoms were concerned in a yearlong trial. So, based on the research that I've come across, it doesn't seem that daily doses of vitamin D3 that are much larger than 5,000 IU have been studied for their antidepressant effects. Jorde et al. (2008) did use what would probably be the equivalent of a 5,714-IU daily dose in their yearlong trial and found it to be significantly more effective in reducing depressive symptoms than placebo, but they also found half as much vitamin D3 to be superior to placebo. It might not be a bad idea to consider trying 5,800 IU of vitamin D3 daily to give yourself the maximum amount of the vitamin that Jorde et al. (2008) gave to their participants, but I tend to have my doubts as to whether an extra 800 IU would make a significant difference.
Other than the dose of vitamin D3 that you're taking, you might want to consider the possibility that staying on vitamin D3 for longer might produce benefits that you're not currently experiencing. When evaluating the effects of 4,000 IU of vitamin D3 daily on biochemical responses and well being of older adults, Vieth et al. (2004) found that the vitamin seemed to produce the greatest biochemical responses after six months of supplementation. Consistent with this, the results of a study by Mocanu and Vieth (2014) seem to indicate that vitamin D levels may continue to rise with daily vitamin D3 supplementation for longer than what was previously believed. For the study, Mocanu and Vieth (2014) gave participants in a nursing home bread fortified with 5,000 IU of vitamin D3 on a daily basis for a year. Vitamin D levels in the participants rose from a baseline mean value of 28.5 +/- 10.8 nmol/L to 127.3 +/- 37.8 nmol/L following the yearlong supplementation period. A year after the end of the supplementation period, mean vitamin D levels only dropped to 64.9 +/- 24.8 nmol/L. It wasn't until the follow-up period three years after the end of the supplementation period when vitamin D levels in the participants dropped to around their baseline level, ending up at a level of 28.0 +/- 15.0 nmol/L. So, if the data that I just presented are to be believed, it might be the case that as you continue to supplement with vitamin D3 for longer, your vitamin D levels will continue to rise. Of course, it can't be guaranteed that doing this would lead to eventual clinical improvement, even if your vitamin D levels do keep rising. I most certainly hope that you will see this "clinical improvement" someday, though, whether it's from supplementing with vitamin D3, from supplementing with vitamin D3 along with doing other things, or by just doing other things.
Tomatheus
==
REFERENCES
Gloth, F.M. 3rd, Alam, W., & Hollis, B. (1999). Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. The Journal of Nutrition, Health & Aging, 3, 5-7. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/10888476/
Jorde, R., Sneve, M., Figenschau, Y., Svartberg, J., & Waterloo, K. (2008). Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: Randomized double blind trial. Journal of Internal Medicine, 264, 599-609. Article: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2008.02008.x/full
Khoraminya, N., Tehrani-Doost, M., Jazayeri, S., Hosseini, A., & Djazayery, A. (2013). Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. The Australian and New Zealand Journal of Psychiatry, 47, 271-275. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/23093054/
Mocanu, V., & Vieth, R. (2013). Three-year follow-up of serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in nursing home residents who had received 12 months of daily bread fortification with 125 ug of vitamin D3. Nutrition Journal, 12, 137. Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874673/
Vieth, R., Kimball, S., Hu, A., & Walfish, P.G. (2004). Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutrition Journal, 3, 8. Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC506781/
Posted by SLS on January 28, 2016, at 5:48:05
In reply to Re: ALL OK » SLS, posted by Tomatheus on January 27, 2016, at 22:01:49
Posted by Escapee on January 28, 2016, at 9:10:42
In reply to Re: ALL OK » Tomatheus, posted by SLS on January 27, 2016, at 19:27:44
> I'm taking 5000 IU/day of vitamin D3. Maybe I should take more?
>
>
> - ScottI'm taking 4000iu vit D3. 3 'high' dose 75mcg and 25mcg from a multi. I always get confused with the mcg to iu conversion, but I thought this was alot. Tho recently Read people taking 8mg without ill effects. I dont go outside alot when im home, but is it worth taking doses so hi? What would that be in mcg? thanks
Posted by Lamdage22 on January 28, 2016, at 9:18:57
In reply to Re: ALL OK » SLS, posted by Escapee on January 28, 2016, at 9:10:42
i took 3500 iu of vitamin d. 25oh-vit d was "45". I want it at 70 so now i take 6000 iu. Looking to stabilize at 5000 and then test again.
Posted by Escapee on January 28, 2016, at 9:31:14
In reply to Re: ALL OK, posted by swim on January 27, 2016, at 11:57:11
> I told my psychiatrist today that i'v raised my pregabalin dosage from 300mg to 450mg whereupon she said i'm self-medicating and walked off.
Just wondering, who signs the prescription? As long as its signed you are not self prescribing. increasing the dose maybe but walking out on you like that is in my view malpractice. Do you pay for the service and meds? Oh, and is 450mg over the limit? Ur in the USA?
Posted by Escapee on January 28, 2016, at 11:13:30
In reply to Re: ALL OK » Escapee, posted by Tomatheus on January 26, 2016, at 16:26:36
Also, if you don't mind me asking, what nootropics are you currently taking? And what do they seem to help with?
>
> Enough questions from me, though. I'm glad to hear that you could tell your pdoc that you were feeling better. Take care.
>
> TomatheusAlpha-GPC & Citicoline (both precursors to acetyl-choline. I plan to ditch the Alpha GPC when I've finished the bottle. Seems citicoline does the same job & more. I see no point to carry on with. I'll find that out when I stop. My fave nootropic is aniracetam which is calming yet highly focusing at the same time. Helps SA to a point. I'm currently take oxiracetam as finding stocks of aniracetam online has become hard. But oxiracetam there seems plenty of. Being a precursor to amipiracetam, oxy seem more stimulating.
Infact, it seems theres a racetam for every occasion lol
Posted by Tomatheus on January 28, 2016, at 12:50:34
In reply to Re: ALL OK » Tomatheus, posted by Escapee on January 28, 2016, at 11:13:30
> Alpha-GPC & Citicoline (both precursors to acetyl-choline. I plan to ditch the Alpha GPC when I've finished the bottle. Seems citicoline does the same job & more. I see no point to carry on with. I'll find that out when I stop. My fave nootropic is aniracetam which is calming yet highly focusing at the same time. Helps SA to a point. I'm currently take oxiracetam as finding stocks of aniracetam online has become hard. But oxiracetam there seems plenty of. Being a precursor to amipiracetam, oxy seem more stimulating.
> Infact, it seems theres a racetam for every occasion lolQuite interesting. Yes, I do seem to recall having had some difficulty finding aniracetam suppliers online, back when I tried taking it several years ago. Anyway, thank you much for your response.
Tomatheus
Posted by Escapee on January 28, 2016, at 12:57:51
In reply to Re: ALL OK » Tomatheus, posted by Escapee on January 28, 2016, at 11:13:30
>I'm currently take oxiracetam as finding stocks of aniracetam online has become hard. But oxiracetam there seems plenty of. Being a precursor to amipiracetam, oxi seem more stimulating.
I made an error. Oxiracetam is not a precursor to aniracetam, rather a metabolite of aniracetam.
Posted by swim on January 30, 2016, at 11:48:52
In reply to Re: ALL OK » swim, posted by Escapee on January 28, 2016, at 9:31:14
> > I told my psychiatrist today that i'v raised my pregabalin dosage from 300mg to 450mg whereupon she said i'm self-medicating and walked off.
>
> Just wondering, who signs the prescription? As long as its signed you are not self prescribing. increasing the dose maybe but walking out on you like that is in my view malpractice. Do you pay for the service and meds? Oh, and is 450mg over the limit? Ur in the USA?
>Unfortunately i'm not from the UK, 450mg is not the maximum dosage, max is 600mg. I really do need to find more open-minded doc, it isn't easy where i live though, all the doc's i'v been to are very conservative, it's like i have to beg for any new med i like to try and after that they charge me top . It is really hard to find something to work if the procedure has been made so hard. It really was very rude from her to walk off like this, she doesn't know how i feel and what works for me, only i can tell how i feel.. the system really pisses me off sometimes
Posted by Escapee on January 30, 2016, at 15:19:45
In reply to Re: ALL OK, posted by swim on January 30, 2016, at 11:48:52
> > Just wondering, who signs the prescription? As long as its signed you are not self prescribing. increasing the dose maybe but walking out on you like that is in my view malpractice. Do you pay for the service and meds? Oh, and is 450mg over the limit? Ur in the USA?
> >
>
> Unfortunately i'm not from the UK, 450mg is not the maximum dosage, max is 600mg. I really do need to find more open-minded doc, it isn't easy where i live though, all the doc's i'v been to are very conservative, it's like i have to beg for any new med i like to try and after that they charge me top . It is really hard to find something to work if the procedure has been made so hard. It really was very rude from her to walk off like this, she doesn't know how i feel and what works for me, only i can tell how i feel.. the system really pisses me off sometimes
>
Dam! I see your predicament. Like I said before, you need a Neuro-psychopharmacologist. These specialist are meds meds MEDS!!! When I last saw my specialist, when I told him that i had increased my dose myself he said nothing. At the end of the appointment he congratulated me that I was doing so better! It was a high dose too. All he said was that it was so good to see me so un-depressed! with smiles all round. Would you be willing to travel for your appointment? OR, If you contacted Professor David Nutt At the Imperial college in London he may well know someone near where u live who you can call for intelligent help.
http://www.imperial.ac.uk/people/d.nutt
He's great. I use to be under his care until I was passed to my current doc. He's a total wizard in psycho-pharmacology. Only doc who okayed me adding 300mg bupropion to my MAOI then add Amitriptyline The link has his email address. He does move around alot though. So I cannot guarantee he himself can help. But he should be willing to share a few names he knows in USA. I hope something positive happens for u soon.
Escapee
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